All of these incisions selleck inhibitor can become problematic in the setting of infection, but thankfully infection risk is low with this approach (see Table 1). Another important cosmetic consideration is performing the initial incision through the skin and dermis layers only. Cephalad dissection superficial to the orbicularis oculi, pericranium, and temporalis muscle is important for development of a separate tissue flap for covering the keyhole craniotomy during closure [2, 5, 13, 22, 46]. Additional considerations for a good cosmetic result include proper repositioning of the bone flap. Care must be taken to ensure that the outer cortex of the supraorbital ridge remains intact during the approach. Use of a burr hole cover and square titanium plates prevents the appearance or palpation of the gap between the bone flap and intact native bone following bone flap replacement in the patient.
Final closure of the skin layer with a running subcuticular stitch (e.g., 5-0 Prolene) without any suture knots brings the edges of the eyebrow together for proper cosmesis as well. 5. Conclusions The supraorbital craniotomy and keyhole approach through the eyebrow permit access to a number of lesions in the subfrontal corridor with minimal brain retraction and a much smaller area of potential injury of superficial structures. All minimally invasive techniques have a learning curve, and smaller, simpler lesions should be performed first through this approach before moving on to larger, more complicated lesions. Our experience is that midline and suprasellar lesions are more easily accessed through this approach than laterally based lesions.
Endoscopy can play an important role in improving visualization through the keyhole corridor. Attention to detail can allow this approach to be performed with superb cosmetic results while still achieving surgical efficacy and limiting complications. Acknowledgment The authors have no disclosures. The authors would like to thank Eric Jablonowski for the illustrations in the paper.
Minimally invasive colorectal surgery has been demonstrated to be a safe and efficacious approach for the surgical management of benign and malignant conditions [1�C3]. Conventional multiport laparoscopy was the first utilized minimally invasive surgical modality for the management of colorectal diseases .
Thereafter, hand-assisted laparoscopic surgery was in part developed to overcome some of the technical challenges of conventional laparoscopic surgery . Entinostat These approaches require several incisions for port placement and specimen extraction, which may potentially results in complications such as extraperitoneal insufflation, bleeding, and internal organ injury . In an attempt to progress with less invasive techniques and diminish potential complications, minimally invasive colorectal surgery is trending towards reduced-port modalities.